PHILHEALTH Regional Office VI (PRO-6) recognizes its duty to process and reimburse claim benefits afforded to PhilHealth members in Western Visayas and has paid 83.48 percent of good and complete claims on an average of 27 days from 2020 to 2021.
The regional office has processed and paid 1,197,148 out of the 1,434,130 claims in the amount of P9,367,479,265.58.
Approved for payment are 20,594 or 1.43 percent of claims in the amount of P109,550,908.40, while 5.79 percent or 83,140 benefit claims equivalent to P447,202,635.89 are in-process.
However, several filed claims were returned to hospitals and denied for payment due to discrepancies in claims filing and non-compliance to the rules and procedures set forth by the state insurer.
A total of 109,068 (7.61 percent) in the amount of P689,978,723.00 were returned to the healthcare institutions for compliance with requirements, while 24,180 (1.69 percent) claims amounting to P181,632,786.00 have been denied.
Returned and denied claims that will be re-filed or appealed will undergo validation and re-processing before payment. These are not considered arrears of the Corporation while not yet approved for payment.
PhilHealth reminds healthcare institutions to promptly submit their claim to be validated and paid at the soonest possible time. Data showed that the average turn-around time for accredited HCIs to submit their claims is 79 days upon discharge of the patient, while PhilHealth processes good and complete claims in just 27 days./PN
